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Fracture risk assessment in patients with chronic kidney disease

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Abstract

Fractures are common in patients with chronic kidney disease (CKD) and associated with substantially high morbidity and mortality. Bone mass measurements are commonly used to assess fracture risk in the general population, but the utility of these measurements in patients with CKD, and specifically among those on hemodialysis, is unclear. This review will outline the epidemiology and etiology of fractures in patients with CKD with a particular emphasis on men and women on hemodialysis. As well, we will summarize the published data, which describes the association between risk factors for fracture (including bone mass measurements, biochemical markers of mineral metabolism, and muscle strength) and fractures in patients with CKD. Patients with CKD suffer from fractures due to impairments in bone quantity, bone quality, and abnormalities of neuromuscular function. There is a paucity of evidence on the associations between bone quality, bone turnover markers, neuromuscular function, and fractures in patients with CKD. Furthermore, the complex etiology of fractures combined with the technical limitations of bone mineral density testing, both by dual energy X-ray absorptiometry (DXA) and by peripheral quantitative tomography (pQCT), limits the clinical utility of bone mass measurements for fracture prediction in CKD; this is particularly true among patients with stages 4 and 5 CKD. Further prospective studies to identify noninvasive measures of bone strength that can be used for fracture risk assessment are needed.

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Conflicts of interest

Jamal SA: Advisory Board Member: Novartis, Amgen, Warner-Chilcott; Consulting Fees: Novartis, Warner-Chilcott, Genzyme, Shire; Speaker Fees: Novartis, Amgen, Warner-Chilcott, Genzyme, Shire.

West SL: None.

Miller PD: Scientific Grants: Warner-Chillcott, Genentech, Eli Lilly, Merck & Co., Novartis Pharmaceuticals, Amgen; Speaker Boards/Advisory Boards/Consultation: Warner-Chilcott, Merck & Co., Eli Lilly, Amgen, Novartis Pharmaceuticals, Genentech, GlaxoSmithKline.

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Authors and Affiliations

  1. Department of Medicine, University of Toronto, Toronto, ON, Canada

    S. A. Jamal

  2. Women’s College Research Institute, 790 Bay Street, room 725, Toronto, ON, Canada, M5G 1N8

    S. A. Jamal

  3. Department of Exercise Sciences, University of Toronto, Toronto, ON, Canada

    S. L. West

  4. Women’s College Research Institute, Toronto, ON, Canada

    S. L. West

  5. Colorado Center for Bone Research, Lakewood, CO, USA

    P. D. Miller

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  1. S. A. Jamal
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Jamal, S.A., West, S.L. & Miller, P.D. Fracture risk assessment in patients with chronic kidney disease. Osteoporos Int 23, 1191–1198 (2012). https://doi.org/10.1007/s00198-011-1781-0

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